View source for Order Sets in Computerized Physician Order Entry System: an Analysis of Seven Sites

Article Review Wright, A., Feblowitz, J. C., Pang, J. E., Carpenter, J. D., Krall, M. A., Middleton, B., & Sittig, D. F. (2012). Use of Order Sets in Inpatient Computerized Provider Order Entry Systems: A Comparative Analysis of Usage Patterns at Seven Sites. <ref name= "OrderSetAnalysis">Wright, A., Feblowitz, J. C., Pang, J. E., Carpenter, J. D., Krall, M. A., Middleton, B., & Sittig, D. F. (2012). Use of Order Sets in Inpatient Computerized Provider Order Entry Systems: A Comparative Analysis of Usage Patterns at Seven Sites. International Journal of Medical Informatics, 81(11), 733–745. http://doi.org.ezproxyhost.library.tmc.edu/10.1016/j.ijmedinf.2012.04.003/</ref>


== Introduction ==

Most [[CPOE|CPOE]]systems have built-in support for [[Order Set|order sets]] (collection of orders grouped by a clinical purpose).  Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering.  Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created. The goal of this study is extend what is already known about order sets by doing the first multi-site analysis of order set utilization with a cross-sit comparison of user behaviors.

== Methods ==

Ten health care institutions were requested to participate in study that requested to provide anonymized data logs with date, time and order set name for each instance of order set utilization over the course of one year.  Seven of the ten institutions participated in the study.  The data was loaded in Microsoft Access database.

== Results ==

The data was analyzed and the top ten order sets were identified from each of the seven sites.  Although each site had unique order sets identified, there were some common themes such as;

* General admission orders
* Surgical / Anesthesia Orders
* Critical Care Admission 
* Clinical Pathways
* Diabetes Orders

In addition, this study looked at the cumulative distribution of utilization of the order sets.  It was determined that a small number of order sets used frequently made up the majority of order set category.  This is know as the power law or 80/20 rule.

== Conclusion ==

This study determined that order sets were widely used in these seven health care facilities.  The number of participants is considered to be a limitation, but it gave important information on the common themes that all of them were mostly using.  The commonalities include generic and condition-specific admission order sets, surgical sets, and clinical pathways. This knowledge can aid future implementations of CPOE and [[CDS]] systems in determining which order sets should be developed first.

== Comments ==

CPOE has impacted all areas of health care. CDS has strengthen the appropriateness of the same and allow for order sets to be created. In order to achieve the maximum effect in efficiency, it is needed to not only create order sets based in evidence, but also taken in consideration clinical experience and preference.  When the implementation team has a base idea which order sets should be developed first, it will expedite the process of creating and reaching out to the correct stakeholders.

== References ==
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[[Category: Reviews]]
[[Category: CPOE]]
[[Category: Order Sets]]
[[Category: HI5313-2015-FALL]]
[[Category: CDS]]